Addison Court

Addison Court is a residential care home providing personal and nursing care to up to 70 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 62 people using the service.

People’s experience of using this service and what we found

The provider did not always act robustly to investigate and support people raising concerns about their care. The safeguarding log did not accurately record action taken or lessons learnt from reviewing safeguarding concerns. The provider did not always ensure risks were assessed and mitigated. Although sufficient numbers of staff were on duty. On the days of the inspection the use of agency staff had increased. These staff told us that they did not know people’s needs well enough. The provider did not recruit new staff in line with the regulations and their own procedures. People and relatives gave mixed feedback about staffing levels.

The provider’s quality monitoring systems had not been used effectively to ensure trends were identified, fully investigated and lessons learnt following incidents, accidents and falls. Records did not demonstrate complaints had been fully investigated. Duty of candour requirements were not always followed and there had been a lack of management oversight at the service.

The provider's staffing dependency tool did not account for all factors which impacted on staffing levels. We have made a recommendation about this.

Improvements were required to ensure people had a positive mealtime experience. Records did not always demonstrate how staff supported people to achieve their target fluid levels. We have made a recommendation about this.

Care reviews, involving relatives where appropriate, had not been carried out as planned. Some care plans were not up to date or contained conflicting information.

Staff spoke positively about the people they supported. They told us the care at the home was good enough for their family or friends. Three staff had been nominated for an “Angel award” in recognition for their outstanding contributions to the local community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Checks were completed to maintain a safe environment. Staff knew about the whistle blowing procedure and were confident to raise concerns. Staff followed good infection prevention and control (IPC) practices. People were supported to access healthcare services in line with their particular needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 October 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also prompted in part due to concerns received about staffing levels, moving and assisting, recruitment and management oversight. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and recommendations

We have identified breaches in relation to person-centred care, safe care and treatment, safeguarding, complaints, good governance, fit and proper persons employed and duty of candour.

Following our inspection, we have issued the provider with a Warning Notice relating to the breach associated with fit and proper persons employed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Addison Court is a residential care home providing personal and nursing care to up to 70 people. The service provides support to people aged 65 and over, some of whom are living with a dementia. At the time of our inspection there were 56 people using the service.

People’s experience of using this service and what we found

People were happy with the support they were provided by staff. Relatives were complimentary about the staff team at the home. We observed many kind and caring interactions between staff and people throughout the inspection. Relatives and visitors were welcomed into the home and people were supported to take part in activities that were meaningful to them.

Medicines were generally safely managed but we found that further worked was needed around the records relating to ‘as required’ medicines and topical medicines. We have made a recommendation about this.

Risks people may face were clearly recorded and steps in place for staff to follow to keep people safe. Care records were detailed and provided guidance for staff to follow to meet people’s needs. People and relatives were involved in reviews of people’s care needs as well as other health care professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The home was clean, and staff were wearing appropriate PPE whilst supporting people. Staff followed government guidance in relation to COVID-19. There was enough staff to safely support people.

There was an effective quality and assurance system in place which allowed for oversight and identify areas of improvement of the care and support provided. People, relatives and staff were asked for their feedback about the service and this feedback was used to improve the quality of care provided. The registered manager investigated all incidents and complaints, and used the lessons learned to improve the service.

Rating at last inspection

The last rating for this service was good (published 16 September 2020).

Why we inspected

We received concerns in relation to medicines management, people’s care needs not being met, staffing and leadership at the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed and remains good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Addison Court on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation that the provider ensures that records relating to ‘as required’ medicines and topical medicines are fully reviewed.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had continually reviewed changing guidance and interpreted it appropriately. For instance, ensuring a member of staff who was not working directly with vulnerable people could return to work earlier as the self-isolation guidance allowed.

The service had introduced a staff counselling service during the pandemic, recognising the emotional and wellbeing impact of the pandemic on staff.

The registered manager responded promptly to advice from infection control specialists.

Further information is in the detailed findings below.

Addison Court accommodates up to 70 people with residential care and nursing needs in a purpose-built building. 54 people were using the service at the time of the inspection.

People’s experience of using this service and what we found

Risks were well managed. People who had wound and skin care needs received appropriate care and treatment. Lessons had been learned following incidents and shared with staff. There were enough staff on duty to meet people’s needs

Appropriate infection prevention and control procedures were in place to reduce the risk of infection and to keep people safe.

The provider and management team carried out audits to monitor the quality of the service and ensure they delivered a high standard of care. The registered manager and staff worked in partnership with other health and social care professionals to achieve positive outcomes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 3 January 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about wound and skin care, staffing and overall governance. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected the service to follow up on the breaches from the previous inspection and to carry out a comprehensive inspection.

At the last inspection in August 2017 the service was not meeting all of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regard to regulation 18, staff training.

At this inspection we found improvements had been made and the service was no longer in breach of regulation 18.

Addison Court is a care home that provides accommodation and nursing or personal care for a maximum of 70 older people including people who may live with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Addison Court accommodated 59 people at the time of the inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Appropriate training was now provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

People said they felt safe and they could speak to staff as they were approachable. People and staff told us they thought there were enough staff on duty to provide safe care to people. Staff knew about safeguarding procedures. Staff were subject to robust recruitment checks. Arrangements for managing people's medicines were safe.

Detailed records reflected the care provided by staff. Care was provided with kindness and people's privacy and dignity were respected. Communication was effective to ensure people, staff and relatives were kept up-to-date about any changes in people's care and support needs and the running of the service.

Staff were skilled and knowledgeable about each person they cared for and they were committed to making a positive difference to each person. There was clear evidence of collaborative working and excellent communication with other professionals to ensure people’s care and treatment needs were met.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Activities and entertainment were available to keep people engaged and stimulated.

The home was being refurbished and people were very positive about the changes taking place. There was a good standard of hygiene. The environment promoted the orientation and independence of people who lived with dementia.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service.

The service was last inspected in January 2017, at which time the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, specifically Regulation 12 (safe care and treatment). We found medicines were not managed, stored or audited appropriately at the previous inspection. At this inspection we found medicines were managed appropriately and a range of improvements had been made.

At the previous inspection of January 2017 we rated the service as good. At this inspection we rated the service as requires improvement.

Before the inspection in January 2017 we were notified of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result both this and the previous inspection did not examine the circumstances of the incident.

However, since the date of the last inspection a further review of the incident has been carried out and identified potential concerns about the management of risk of falls from moving and handling equipment. This inspection examined those risks.

Addison Court is a care home in Crawcrook, Tyne and Wear. It is registered to provide accommodation for up to 70 people who need nursing and personal care. It provides a service primarily for older people, including people living with dementia. There were 57 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the storage, administration and disposal of medicines. This was generally found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). Where there were individual discrepancies or errors, we found the registered manager’s auditing system had also picked up on these areas and an action plan was in place. The registered manager’s medicines auditing process was robust.

Treatment rooms were clean, tidy and temperatures were recorded. Other areas of the building were clean and some carpeting had been replaced with vinyl flooring to ensure it was easier to clean. Additional hours for domestic staff and new cleaning products had also been sourced.

Risks to people were managed through risk assessments and associated care plans. These risks were reviewed regularly and, where appropriate, included or made reference to advice from healthcare professionals to keep people safe.

Staff were knowledgeable regarding safeguarding principles and what potential signs of abuse to look out for. People we spoke with and their relatives consistently told us the service maintained people’s safety. External professionals all agreed the service had improved in recent months and that they had no major concerns.

There were pre-employment checks of staff in place, including identity and Disclosure and Barring Service checks. There were enough staff deployed to meet people's needs safely.

Staff completed a range of training, such as safeguarding, health and safety, fire awareness, nutrition, dignity, moving and handling, dementia awareness, infection control and first aid. The system the registered manager used to monitor staff training demonstrated that training had not been delivered regarding breakaway training or the Mental Capacity Act.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager displayed a good understanding of capacity and we found the provider had followed the requirements in the DoLS. Best interest decisions however were not completed in line with MCA guidance, meaning the involvement of people who knew people’s needs best, such as family members or clinicians, was not always documented.

Staff told us they were well supported and we saw supervisions and appraisals had happened or were planned.

Mealtimes were pleasant, with people given a choice of meals. The chef was passionate about providing high quality food to people’s preferences and feedback regarding food was consistently strong.

Staff had built friendly relationships with people who used the service and people told us they knew staff well.

The premises benefitted from aspects of dementia-friendly design, such as tactile wall displays and clear signage, whilst corridors were bright and spacious.

Care planning documentation was sufficiently detailed and staff displayed a good knowledge of people’s needs, likes and dislikes. Handover documentation was not sufficiently detailed and required improvement.

Group activities were planned by two activities coordinators and people who used the service told us they enjoyed these activities.

The atmosphere at the home was calm and people who used the service confirmed they felt at home.

Staff, people who used the service, relatives and external professionals we spoke with knew the registered manager and were confident in their abilities. There was a strong consensus of opinion that they were making positive changes to the service that would benefit people who used the service.

The registered manager and their deputy had not at the time of this inspection had sufficient time to focus on all aspects of auditing work and we found some quality assurance work had not identified some of the areas for improvement which the inspection had. The registered manager had completed a number of shifts as nurse in charge, as had the deputy. The registered manager confirmed the deputy would be able to complete auditing and other support the following week, with the planned 11 hours supernumerary in place.

Addison Court is registered to provide accommodation for up to 70 people who need nursing and personal care. It provides a service primarily for older people, including people with dementia. It is owned and operated by the provider Malhotra Care Homes Limited. At the time of our inspection there were 53 people accommodated there.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed and applications made to appropriately deprive people of their liberty were made. However DoLs were not always correctly implemented. We made a recommendation about this.

As part of their recruitment process the service carried out background checks on new staff. Staff were aware of how to identify and report abuse. There were policies in place that outlined what to do if staff had concerns about the practice of a colleague.

Care plans were person centred and showed that individual preferences were taken into account. Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare. Though people were involved in information gathering about their preferences they were not always involved in the final stages of care planning, we made a recommendation about this.

People who used the service told us that they liked the people who supported them and thought the majority were caring and polite.

Staff had received training to support them to deliver care safely and effectively. The registered manager had identified areas for development in the overall training of staff and was sourcing appropriate training. The manger was also making improvements around supervision and appraisal.

People were supported to maintain their health and to access health services if needed.

People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed. However the service did not always communicate about people’s nutritional needs effectively. We made a recommendation about this.

Staff had developed caring relationships with people and communicated in a kind and professional manner. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak to about any concerns they had.

The service regularly sent questionnaires to people who used the service and their relatives to ascertain they were satisfied with the service. The registered manager had a clear vision for the future of the service.

The service did not manage medicines appropriately. They were not correctly stored, monitored or signed for correctly when administered. Clinical rooms and medication trolleys were disorganised and unclean.

Though equipment in the home was clean and well maintained some pressure mattresses had not been set properly according to people’s weight. Changes were made during the course of our inspection to rectify these issues.

There was a malodour in some areas of the home. The registered provider agreed that this was not acceptable and began reviewing potential solutions immediately. We made a recommendation about this.

We found a breach of the Regulations in relation to safe care. You can see what action we have asked the provider to take in relation to this.

We undertook this focused inspection to check they had made improvements regarding the three breaches of legal requirements. This report only covers our findings in relation to those legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Addison Court on our website at www.cqc.org.uk.

Addison Court is a care home providing accommodation and personal care for up to 70 people who need nursing and personal care. It provides a service primarily for older people, including people living with dementia. At the time of the inspection there were 56 people accommodated there.

A manager was in post at the time of the inspection, however they had yet to become formally registered with CQC. They had applied to become registered and their application was being determined at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found some action had been taken to address previous concerns about safe care and treatment, but improvements were not consistent or sustained.

Improvements had been made to the way people were supported when using their wheelchairs. Foot plates were used when staff assisted people in their chairs to avoid the risk of foot entrapment.

Areas of concern remained. We found a significant delay from staff finding a person had developed a pressure ulcer to them implementing a care plan and monitoring the wound site. Records for the administration of topical medicines (creams applied to the skin) had long gaps. Instructions for how these medicines were used were not always clear. A person’s pain was not well managed and a delay in this being raised and followed through with the person’s GP was highlighted to the manager for immediate attention.

Improvements were still required to the governance of the service. The frequency of management audits for medicines and infection control, although undertaken, had reduced. Staff practice was not always improved when issues were identified. For example, hand hygiene and medicines storage issues identified through internal audits had not been resolved. Expected standards were not communicated to the staff team in a structured or consistent manner.

We found continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment and good governance.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. We found safeguarding procedures were in place and staff understood how to safeguard the people they supported. One relative told us, 'It's good care and treatment here and he's safe. He's treat well here and there's nothing untoward to worry about.' Another relative commented, 'It's reassuring that she's well looked after and safe here.'

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. One person commented, 'They're always in and out checking' staff come quickly.' One relative told us, 'There's enough staff to look after people here. There are occasions when they are pushed, like holiday time and staff training days, but it's generally ok when I'm here.'

The building and grounds were well-maintained, secure and other appropriate measures were in place to ensure the security of the premises.

Is the service effective?

People and their relatives told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us, 'I'm well looked after, they're all really good' smashing.' A relative told us, 'The staff are all polite, always pleasant and so respectful.'

We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. Staff received appropriate professional development, appraisal and supervision and the provider monitored training requirements appropriately.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'The staff are very patient and caring; very much so.' Another person said, 'The staff are nice, kind and caring.' Relatives' comments included said, 'Overall, we are very happy with his care. He is happy and content here, the staff do a grand job and they are all very caring,' and, 'They treat her nicely and genuinely seem very caring and it's obvious that they want to do their job.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed regularly to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

We saw the provider had a written complaints policy and procedure, which detailed the process that should be followed in the event of a complaint. The registered manager told us, and records confirmed that no complaints had been received by the service within the last six months.

We saw the service had policies and procedures in place in relation to the safeguarding of adults. This meant that people were safeguarded as required and the provider was able to respond appropriately to any potential allegations of abuse.

Is the service well-led?

The service had a registered manager in post and the provider had in place systems to monitor the quality of the service people received.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People's relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Both staff, people who used the service and their relatives said communication was good. One relative told us, 'We are always having meetings; they happen every month. Before the new management came in, you used to say something, or raise anything and it was ignored. We used to get fed up with mentioning things and asking for stuff ' it was pointless having a meeting. The new management have made a massive difference and it gets sorted now; I'd highly recommend the new management for that.'

Staff received regular supervision and appraisal and told us they felt supported by the management team. Staff comments included, 'They are going to be the best we have ever had,' and, 'These are going to be the best managers we have had.'

A member of the management team was available on call for advice and support and in case of emergencies.

We saw people were cared for effectively and care was planned to meets individuals needs.

We found there was sufficient staff to provide care and support.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We carried out this inspection following concerns about people's care, treatment and wellbeing. During this inspection we were helped by a tissue viability and a dietary specialist. We also examined matters the provider had to notify us about.

People's care was not always accurately assessed or planned in a way that ensured they received appropriate care and treatment. Accurate care plans were not in place for a recently admitted person.

People using the service did not always receive the care and support they needed. We observed staff were courteous to people, however we saw a person being helped to move in an unsafe way. People did not always get the help they needed to minimise the risk of developing pressure ulcers. We saw some people who needed pressure relieving aids (such as air flow cushions) did not have all the equipment they needed and positional changes were only monitored when in bed. At times staff were rushed and we had to prompt staff to help a person with their continence.

People told us they were happy with the food provided. We found people received a suitable and nutritious choice of food, which met their health and cultural needs. People's dietary needs were identified and monitored, with appropriate support provided.

We found that although some matters which had to be reported to had been, several had not. This included some deaths in the home, matters reported to or investigated by the police and some allegations or incidents of abuse.

People received the care they needed and made positive comments about the care received. People said they were happy with the care and support provided. One person remarked; 'It doesn't matter what you want, they're here for you.' Another said; 'They come quick when you call.' We observed people being cared for with dignity and respect and saw staff promoted people's independence. We observed staff were busy, but well organised which created a calm and relaxed atmosphere.

We saw staff provided help with medicines in a safe way, with clear records kept.

We toured the home and found there was a high standard of accommodation and plentiful equipment to help meet people's care needs. We saw some fire doors had been prevented from closing and the some equipment servicing was overdue.

People told us they were happy with the staff who worked with them and we observed staff members acting in a courteous and professional manner. One person remarked about a staff member; 'They have been very, very kind.' A visiting relative we spoke with made similarly positive comments about the staff who worked here.

We checked a sample of records and found these were up to date, accurate and securely stored.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.